title: Prognostic value of N-terminal probrain natriuretic peptide level on admission in patients with acute myocardial infarction and preserved left ventricular ejection fraction.
abstract: BACKGROUND
  Little is known about the prognosis of patients with acute myocardial infarction (MI) and preserved left ventricular ejection fraction (LVEF), a condition that is becoming increasingly common. This study sought to identify independent predictors of adverse outcomes in patients with acute MI and preserved LVEF.
  
  
  METHODS
  We studied the prognosis of 555 patients with acute MI (mean age 62 years, 287 men) and preserved LVEF (>40%). Primary endpoint was a composite of cardiovascular (CV) death and rehospitalization for heart failure (HF).
  
  
  RESULTS
  During follow-up of a median 24 months (range 0-50 months), there were 34 cardiac events (cardiac death in 28 and rehospitalization for HF in six patients). Significant univariate predictors of CV death and rehospitalization for HF were age, Killip class greater than I, revascularization, estimated glomerular filtration rate, log N-terminal probrain natriuretic peptide (NT-proBNP), LVEF, left atrial volume index, and the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity (E/E') greater than 15. In multivariate Cox analysis, age (hazard ratio 1.05, 95% confidence interval: 1.01-1.09, P=0.02) and log NT-proBNP (hazard ratio 2.08, 95% confidence interval: 1.61-2.70, P<0.001) independently predicted CV death and rehospitalization for HF. Receiver operating curve analysis indicated that NT-proBNP showed significantly higher areas under the receiver operating characteristic curve value than other significant predictors including left atrial volume index and estimated glomerular filtration rate for prediction of adverse outcomes.
  
  
  CONCLUSIONS
  NT-proBNP showed a strong predictive power for adverse outcomes beyond traditional risk factors and echocardiographic indices of LV systolic and diastolic function in patients with acute MI and preserved LVEF.
authors.affiliation: Division of Cardiology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Sung-Ai
authors.initials: SA
authors.lastname: Kim
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Rhee
authors.forename: Chi-Young
authors.initials: CY
authors.lastname: Shim
authors.forename: Jung-Sun
authors.initials: JS
authors.lastname: Kim
authors.forename: Sungha
authors.initials: S
authors.lastname: Park
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Namsik
authors.initials: N
authors.lastname: Chung
authors.forename: Jong-Won
authors.initials: JW
authors.lastname: Ha
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain